DCMedical News: Friday, May 10, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, May 10, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
The President Says He Doesn’t Like High Drug Prices or Surprise Bills
The President made a statement (transcript here) as part of a news conference in the White House Thursday, focused on drug prices and “surprise” (out-of-network, unanticipated) bills. He said, “The Republican Party — I have to say this — is, really, very much becoming the party of healthcare. You see what we’re doing. We’re determined to end surprise medical billing for American patients.”
He said, “[L]ast year, drug prices saw their first decline in 46 years. First time in 46 years that drug prices have gone down. And now they’re going to be going down a long way further, including the fact that we may allow states to buy drugs in other countries if we can buy them for a lesser price — substantially less price.”
With regard to surprise bills, the President said “For too long, surprise billings — which has been a tremendous problem in this country — has left some patients with thousands of dollars of unexpected and unjustified charges for services they did not know anything about and, sometimes, services they did not have any information on. They weren’t told by the doctor. They weren’t told by the hospitals in the areas they were going to. And they get, what we call, a ‘surprise bill. ‘Not a pleasant surprise; a very unpleasant surprise. So this must end. We’re going to hold insurance companies and hospitals totally accountable.” (Italics added.)
The President held a colloquy concerning patients who had received such bills, asking them to tell their stories. One such story involved a doctor from Ohio whose daughter had back surgery in Houston; the doctor would have paid $100 for a urine test [cost approx.. $10] in network, but received a bill for $17,850. The President said “[W]e’re going to be announcing something, I think over the next two weeks, that’s going to bring transparency to all of it. And I think, in a way, it’s going to be as important as a healthcare bill. It’s going to be something really special.”
Another interchange took place with health policy authority and reformer Dr. Martin Makary (misspelled as Dr. McKary in the transcript) of Johns Hopkins. Dr. Makary said “People are getting hammered right now. When hospitals were built, they were built with a charter specifying — most of them — that they would be a safe haven or a place of refuge for the sick and injured regardless, according to their charter — regardless of race, ethnicity, or one’s ability to pay. Yet, today, surprise bills are hammering everyday Americans. They’ve done nothing wrong. They work and have a job and they have insurance, and they’re getting hammered. In my own profession of surgical oncology, we see now that half of women with stage-four breast cancer report being harassed by medical bills. That’s a disgrace to my specialty. That’s a disgrace to the medical profession. And that’s a disgrace to our country. We can do better. Hospitals and healthcare can get their act together to provide one honest and fair transparent bill so we can restore medicine to its mission and finally stop the erosion of the public trust that we’re seeing.”
The President outlined the principles of legislation he would propose or endorse. “First, in emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay. So-called balance billing should be prohibited for emergency care. Pretty simple. Second, when patients receive scheduled, non-emergency care, they should be given a clear and honest bill upfront. That means they must be given prices for all services and out-of-pocket payments for which they will be responsible. This will not just protect Americans from surprise charges; it will empower them to choose the best option at the lowest possible price. Third, patients should not receive surprise bills from out-of-network providers that they did not choose themselves. Very unfair. Fourth, legislation should protect patients without increasing federal healthcare expenditures. Additionally, any legislation should lead to greater competition, more choice — very important —and more healthcare freedom. We want patients to be in charge and in total control.
And finally, in an effort to address surprise billing, what we do is, all kinds of health insurance—large groups, small group, individual markets, everything. We want everything included.” A Commonwealth Fund paper on the “underlying causes of surprise medical bills” is here. Modern Healthcare reports on contract reform (here) and White House backing for contract reform (here) as solutions to surprise medical bills.
The President continued his colloquy with Senators Barrasso (an orthopedic surgeon) and Alexander (Chair of the Senate HELP Committee, former Governor of Tennessee, Chair of the National Governors Association, former President of the University of Tennessee, not running for re-election in 2020). At pg. 9 of the linked transcript the topics turn to North Korea, Chinese trade, the Mueller report, John Bolton, Don Jr., and aid to Puerto Rico.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
CDC Reports on Maternal Death in the U.S., Says 60% Preventable
The CDC issued a report in MMWR Vital Signs (here) on maternal death in the U.S. Highlights: “Roughly 60% of pregnancy-related deaths in the U.S. are preventable . . . Among the other findings: From 2011 through 2015, the rate of pregnancy-related deaths was 17 per 100,000 live births. Some 31% of deaths occurred during pregnancy, 36% on the day of delivery or within a week after, and 33% from 1 week to 1 year postpartum. Cardiovascular conditions, including cardiomyopathy and cerebrovascular accidents, accounted for over a third of deaths. Maternal deaths were about three times more common among black and American Indian/Alaska Native women (43 and 33 per 100,000 live births, respectively) than among white women (13 per 100,000).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
RAND Discovers Hospital Commercial Bills are 241% of Medicare Payments, here, sample local coverage here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Protection for Pre-Existing Conditions Under §1332 Waivers
The House passed (230-183) H.R. 986, here, which would “Prohibit the Health and Human Services and Treasury departments from taking any action to implement or enforce their October 2018 guidance regarding criteria for evaluating Section 1332 state health care plan waivers under the 2010 health care overhaul . . . Section 1332 waivers exempt state health care plans from certain federal requirements under the Affordable Care Act, including requirements related to qualified health plans, tax credits, and individual and employer mandates. To be eligible for such waivers, proposed state plans are required to provide care to a ‘comparable number’ of residents that is ‘as comprehensive’ and ‘as affordable’ as would otherwise be provided under the ACA. The October 2018 guidance modifies guidelines for considering waiver applications, emphasizing that a proposed state health care plan should be evaluated based on the number of residents that would have ‘access’ to comparable coverage under the plan, as opposed to the number of residents that purchase such coverage.” The October 24, 2018 CMS “guidance” in question is here, CMS fact sheet here. Opposition to the House vote was firm, here and here. See also the DCMN “Big Story,” 5-8-2019.
MACRA’s MIPS Panned in Senate Finance Committee Hearing
Members of the U.S. Senate Finance Committee heard Wednesday that the 2015 Medicare Access and CHIP Reauthorization Act, or MACRA’s merit-based incentive payment (MIPS) system has failed to save money and has increased administrative burdens. Brooking’s Matthew Fiedler testified (here) that MIPS has increased administrative cost by $482 million. Similar sentiments were expressed by representatives of the American Academy of Family Physicians (here), the American College of Surgeons (here), the American Medical Association (here) and the American Medical Group Association (here). MACRA and MIPS were attempts to replace the “Sustainable Growth Rate” method for physician payment calculation, passed in 1997, repealed in 2015, only implemented for one year, 2002.
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives.
Committees and Members at https://www.house.gov/committees.
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm.
Committees and Members at https://www.senate.gov/committees/membership_assignments.htm.
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May publication dates: 14 15, 16, 17, 20, 21, 22, 23
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.